股前外侧皮瓣穿支动脉定位方法的研究及临床应用

A study on location technology for perforators of anterolateral thigh flap and clinical application

目的 探讨运用多普勒声波血流探测仪在股前外侧皮瓣（ALT）术前穿支动脉定位方法的改进,检测ABC法是否适用于中国人群.方法 参考ABC法对50例（100侧）健康成年志愿者双侧股前外侧区进行多普勒体表探测,记录探及的所有体表声波点坐标,运用统计学及数学方法分别分析声波点的分布规律,并分析体质量指数（BMI）与穿支分布规律之间的相关性.将总结的规律运用于5例临床接受ALT皮瓣手术患者,验证其临床价值,同时了解多普勒探测的准确性.结果 所有穿支点的总体分布接近于y轴（即髂-髌线）附近,以外侧1.0cm范围内分布最多,平均位于外侧约0.5cm处,穿支B与A、C之间的垂直距离平均在4.0cm左右（4.2cm）;在髂-髌线中点水平及中点下方约4.0cm水平上穿支分布最为密集.本组临床患者探测准确率40%（6/15）,错误率20%（3/15）,探测误差平均1.34cm,在临床可接受的范围内;穿支B与A、C之间的垂直距离接近上述多普勒探测研究结果.本组患者BMI与穿支体表分布规律及探测误差之间的相关性均较差.结论 ABC法用于我国人群时应修改为：以髂-髌线中点外侧0.5cm处为B点,B点远、近端各4.0cm处分别为A点和C点;设计皮瓣时,无论多普勒探测结果如何,都应保证B点周围3.0cm范围及B点至其下方4.0cm之间区域被包括在皮瓣切取范围内.

Objective To explore the improvement of preoperative location technology for anterolateral thigh flap （ALT） cutaneous perforators with handheld Doppler, and to evaluate whether the ABC system is suitable for Chinese population. Methods Totally 50 healthy Chinese adults （ 100 sides） were localized for the perforator signals on bilateral thigh surface by using handheld Doppler. The data was recorded in the form of coordinate. The statistics and mathematics methods were used to analysis the regularity of signal distribution and the dependability between the BMI and the signal distribution. The results were applied in 5 patients who received the operation for ALT flap to prove its clinical value. Results The total distribution of perforator signals was approach to the A-P line. Most signals located between the A-P line and 1 cm lateral （ mean 0.5 cm lateral）. The mean vertical distance between perforator B and perforator A, C was 4.0 cm. The two horizontal planes which appeared most perforator signals were point B （the mid-point of A-P line） level and 4.0 cm distal of Point B level. The accuracy of preoperative detection was 40% （6 of 15 perforators） while the error rate was 20% （3 of 15 perforators）. The mean deviation was 1.34 cm. Conclusion The A-P line was still the reliable guiding line for Doppler detection and flap design. The ABC system was suitable for Chinese population but must be adjusted as follows ： perforator B was marked first at the midpoint and 0.5 cm lateral to the A-P line, perforators A and C were marked 4 cm distal and proximal to perforator B, respectively.